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Biomedical subjects

A Kurz

Publications and source records attributed to A Kurz.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Mild cognitive impairment].

From today's point of view, patients with a mild cognitive impairment (MCI) are at risk for developing a dementia. This clinical picture occurs frequently in the population and is easily recognized through simple tests and interviews conducted in the general and neurological medical practice. A goal of the diagnostics is to detect potentially redressable causes, above all depressive disorders, and to introduce a therapy. In many cases, however, MCI is an early stage of Alzheimer's disease or other neurodegenerative processes. When such a cause is suspected, the most important medical measure is to monitor the progression of the disease so that when deterioration occurs, therapy with antidementia drugs can promptly begin. In the future, patients with MCI will play an increasingly important role as the target group for the prevention of dementia.

Aged↗
PubMed2004

Prion protein codon 129 polymorphism and risk of Alzheimer disease.

The authors investigated the PRNP Met129Val polymorphism in 1,393 subjects including 482 patients with Alzheimer disease (AD) and two independent control groups. In patients, PRNP Met homozygosity conferred increasing risk with decreasing age at onset (onset: 61 to 70 years, n = 151, p = 0.02, odds ratio [OR] = 1.72, 95% CI = 1.2 to 2.53; onset: < or =60 years, n = 138, p = 0.013, OR = 1.92, 95% CI = 1.31 to 2.87), whereas no association was obtained in patients with onset at older than 70 years. The results suggest involvement of the prion protein in the pathogenesis of early-onset AD.

Age of Onset↗
PubMed2004

Ginkgo biloba compared with cholinesterase inhibitors in the treatment of dementia: a review based on meta-analyses by the cochrane collaboration.

Data were derived from the Cochrane Collaboration meta-analyses of the efficacies of ginkgo, donepezil, rivastigmine and galantamine on changes in cognitive function in patients with dementia and, where necessary, were transformed to standardized mean differences. The proportion of patients discontinuing trials was used as a proxy measure of tolerability. Outcomes were assessed after 6 months of treatment. Trial data for cholinesterase inhibitors were more consistent than those for ginkgo, particularly regarding patient populations and outcome measures. Significant benefits on cognition vs. placebo were seen with donepezil, 5 and 10 mg, rivastigmine, 6-12 mg, and galantamine, 16 and 24 mg. Significant benefit vs. placebo with ginkgo was seen only when all doses were pooled. Similar proportions of patients discontinued treatment with ginkgo and placebo. Cholinesterase inhibitors were also well tolerated, although a significantly greater proportion of patients receiving active treatment discontinued vs. placebo with some doses. An evidence-based medicine approach, taking into account the quality of clinical trials, is essential when assessing the safety and efficacy of medications.

Aged↗
PubMed2004

[Current antidementive therapy].

Current antidementive treatment can delay further progress of the symptoms of dementia and should therefore be initiated as early as possible and be of adequate duration. Wherever possible, maximum permissible doses should be given. The efficacy of current antidementive drugs in Alzheimer's disease has been sufficiently documented by relevant studies. The acetylcholinesterase inhibitors, donepezil, galantamine and rivastigmine have been approved for the treatment of mild-to-moderate Alzheimer's dementia, the NMDA inhibitor memantine is approved for moderate-to-severe Alzheimer's disease. Ginkgo biloba or piracetam are alternatives for patients with mild-to-moderate dementia, in whom acetylcholinesterase inhibitors cannot be used.

Activities of Daily Living↗
PubMed2004

Region-specific decline of cerebral glucose metabolism in patients with frontotemporal dementia: a prospective 18F-FDG-PET study.

OBJECTIVE: The aim of this study was to examine the pattern of glucose uptake and the changes over time of metabolic deficits in patients with frontotemporal dementia (FTD). METHODS: 10 patients who had received the clinical diagnosis of FTD underwent positron emission tomography scanning at the time of their first examination (baseline) and at follow-up (after 17.1 +/- 6.0 months). For statistical analysis, we used the SPM 99 software. First, we compared the data of the patients at baseline with an age-matched healthy control group. Second, we compared glucose uptake at follow-up with baseline measurements. RESULTS: Compared with normal controls, FTD patients showed significant metabolic deficits primarily in frontal cortical areas, but also in the caudate nuclei and the thalami. At follow-up, a significant progression of metabolic deficit was exclusively observed in the orbitofrontal parts of the frontal lobe and in the subcortical structures. DISCUSSION: These findings demonstrate that the clinical progression in patients with FTD is accompanied by a region-specific decline in cerebral glucose metabolism.

Brain Chemistry↗
PubMed2004

Donepezil for Alzheimer's disease in clinical practice--The DONALD Study. A multicenter 24-week clinical trial in Germany.

This multicenter open-label clinical trial was designed to investigate the safety and efficacy of donepezil, a selective acetylcholinesterase inhibitor, in the treatment of Alzheimer's disease (AD) in routine clinical practice in Germany. A total of 237 patients with mild-to-moderate AD were treated with donepezil for 24 weeks, 186 completed the study according to the protocol. In the completer group, mean MMSE score for efficacy showed an improvement from baseline of +1.6 points at week 12 (95% CI +1.1 to +2.1) and of +1.1 points at week 24 (95% CI +0.5 to +1.7). In more than 80% of the patients, global tolerability was rated to be very good or good. There were only insignificant effects on ECG parameters. This study confirms the results obtained in previous double-blind trials, which showed that donepezil is effective and well tolerated in patients with mild-to-moderately severe AD.

Aged↗
PubMed2004

[Mild cognitive disorder. Questions of definition, diagnosis, prognosis and therapy].

The syndrome of mild cognitive impairment (MCI) is heterogeneous in terms of aetiology, psychopathology, and prognosis. It is characterised by cognitive deterioration significantly exceeding the decline attributable to aging but not reaching the severity of dementia. The prevalence of MCI is estimated to be 17% in the population over 65 years old. At neuropathological examination, a large proportion of patients with mild cognitive impairment, particularly of the amnestic type, show typical features of Alzheimer's disease. The former progresses to dementia at an annual rate of 10% to 15%. In some cases, however, there is stable impairment or remission. The neurodegenerative process of Alzheimer's disease can be demonstrated in at least some patients using volumetric magnetic resonance imaging, 18-FDG positron emission tomography, or biochemical markers in the cerebrospinal fluid. It is not yet known whether patients with mild cognitive impairment or at least those with predementia Alzheimer's disease can benefit from currently available symptomatic treatments. Patients with early-stage Alzheimer's are an important target group for treatment interventions aiming at slowing the neurodegenerative process.

Adult↗
PubMed2004

[Frontotemporal dementia: specific problems for caregivers].

Frontotemporal dementia is a relatively rare neurodegenerative disease. In the majority of cases the onset is at a presenile age, and changes of behavior as well as alterations of personality and social conduct are predominant symptoms whereas cognitive deficits are mild. Therefore interventions for caregivers including self-help groups and educational programs which are usually tailored to Alzheimer's disease often do not meet the needs of caregivers of patients with FTD. The present paper reviews the clinical features of FTD, outlines the specific problems and burdens that caregivers are faced with, and describes novel interventions for this group of family caregivers.

Age Factors↗
PubMed2004

Cerebral metabolic patterns at early stages of frontotemporal dementia and semantic dementia. A PET study.

OBJECTIVE: To determine the patterns of cerebral glucose metabolism in frontotemporal dementia (FTD) and semantic dementia (SD). METHODS: 25 patients with mild FTD and 9 patients with mild SD as well as 15 healthy age-matched control subjects underwent 18F-FDG- positron emission tomography. Patient scans were compared with control scans using SPM-99. RESULTS: As compared with healthy control subjects patients with FTD showed an extensive symmetrical hypometabolism of the frontal lobes (height threshold P <0.01) which spared the motor cortex. Patients with SD showed a hypometabolism in the whole left temporal lobe and in the right temporal pole. CONCLUSIONS: In the clinical syndromes of FTD and SD two distinct patterns of cerebral metabolism were identified. FTD was associated with frontal hypometabolism, whereas in SD cerebral glucose metabolism was exclusively reduced in the temporal lobes. Our findings are consistent with the notion that FTD and SD begin as strictly lobar neuronal degenerations and that a spread of pathological changes is not seen until more advanced stages.

Aged↗
PubMed2004

Nitrous oxide increases the incidence of bowel distension in patients undergoing elective colon resection.

BACKGROUND: Nitrous oxide rapidly inflates gas-filled spaces such as the intestines; but whether the resulting bowel distension is clinically important remains unclear. We therefore tested the hypothesis that nitrous oxide produces clinically important bowel distension. METHODS: Patients scheduled for colon resection were anesthetized with isoflurane and 35% oxygen and randomly assigned to 65% nitrous oxide (n = 175) or 65% nitrogen in air (n = 169). At the end of surgery, blinded surgeons rated the degree of bowel distension as none, mild, moderate, or severe. Patients reported pain, and nausea and vomiting (PONV) 2 h after surgery. Data are reported as means (SD). P < 0.05 was statistically significant. RESULTS: Morphometric and demographic data were similar in the groups. The duration of surgery was 3.0 (1.2) h in the nitrous oxide group and 3.4 (1.5) h in the air group (P = 0.017). Postoperative self-reported pain scores (visual analog scale, 0-100 mm) were greater in the nitrous oxide group (43 [30] mm) than in the air group (35 [31] mm, P = 0.018). Although the incidence of PONV was similar in the groups, VAS scores for nausea were significantly greater in the nitrous oxide group (P = 0.040). Moderate-to-severe bowel distension was observed in 23% of nitrous oxide patients, but in only 9% of patients in the air group (P < 0.001). The number-needed-to-harm for moderate or severe bowel distension from nitrous oxide was thus seven. CONCLUSIONS: Our results suggest that avoiding nitrous oxide administration during prolonged bowel operations will minimize bowel distension and possibly reduce postoperative pain related to it.

Adolescent↗
PubMed2003

[Treatment of behavioral disorders in dementia with risperidone in psychogeriatric out-patients].

BACKGROUND: The atypical neuroleptic drug risperidone has been approved for the treatment of behavioural and psychological symptoms of dementia for more than three years in Germany. To assess the efficacy and tolerability of risperidone in general practice two open-label prospective studies were performed. PATIENTS AND METHOD: In 7142 patients with dementia the treatment course with risperidone was examined over 6 resp. 8 weeks. Efficacy was evaluated by assessing the target symptoms agitation, aggression, sleep-wake-cycle disturbances, social withdrawal, suspiciousness, and delusion. Furthermore, the global impression was rated by the physician and the caregiver at the end of the study. The tolerability of risperidone was documented by monitoring blood pressure, heart rate, bodyweight, and adverse events. RESULTS: 6170 patients complied with the inclusion criteria for analysis. Risperidone achieved statistically significant improvements of behavioural symptoms at an average dose of 1,5 mg/d (90% of patients received < or = 2 mg/d). 92% of the patients showed a favourable treatment response as defined by a > or = 30% improvement of the total score of the target symptoms. This improvement was already apparent 2 and 3 weeks after the start of treatment, respectively. A subgroup analysis demonstrated statistically significant improvements of target symptoms with risperidone also in patients who had been pre-treated with other neuroleptics. The global impression of physician and caregiver was positive in over 90% of patients. Adverse events were seen in 309 of 6170 patients (5,7%). CONCLUSION: Risperidone was highly effective and well tolerated in the treatment of behavioural disturbances in dementia under routine conditions of general practice.

Aged↗
PubMed2003

Lack of association between a single nucleotide polymorphism within the choline acetyltransferase gene and patients with Alzheimer's disease.

Alterations of the cholinergic system may account for typical clinical and pathophysiological disturbances of Alzheimer's disease (AD). In particular, a marked decline of choline acetyltransferase activity (CHAT) and as a consequence of acetylcholine during the course of the disease has been described. Due to the chromosomal localization of CHAT at 10q11.23 and its possible role in the pathophysiology of AD, CHAT may represent an appropriate candidate gene conferring risk to AD. In fact, a recent study identified a functional single nucleotide polymorphism (SNP) within the first common exon of CHAT, which was associated with AD giving an odds ratio of 3.8 (Neurosci. Lett. 333 (2002) 9). Because of the potential importance of this finding we analyzed this SNP and another functional SNP within exon 9 (rs868749) of the CHAT gene using a German case control sample consisting of 242 patients with AD and 143 cognitively healthy controls. No statistically significant differences were obtained for the previously described polymorphism. In addition, the exon 9 SNP (rs868749) was not polymorphic in the studied population. We conclude that the previously identified polymorphism is not associated with AD.

Aged↗
PubMed2003

[Frontotemporal dementia. Results from "Frontotemporal Demential and Pick's Disease Conference"].

At the Frontotemporal Dementia and Pick's Disease Conference, recent data concerning the epidemiology, diagnosis, and therapy of frontotemporal dementia were presented. Topics included clinical manifestations, differential diagnosis, pathologic and genetic bases of the disease, therapy, and specific problems facing patients and care givers. A consensus in the terminology of this condition was sought.

Dementia↗
PubMed2003

[Features of frontotemporal dementia from the perspective of a special family support group].

Eight spouses of patients diagnosed with frontotemporal dementia (FTD) participated in a special support group. Seven weekly sessions of 90-min duration were held. This pilot project provided the opportunity to learn more about FTD and the specific problems and needs of caregivers. Their problems are predominantly due to changes in the patients' personalities and behaviour, not to the cognitive impairment. Furthermore, in contrast to Alzheimer's disease, patients are relatively young, the current state of scientific knowledge about FTD is unsatisfactory, and the disease is almost unknown among physicians. As part of the group activity, caregivers received information on the typical symptoms of FTD. This enhanced their understanding of the alterations in the patients' personalities and behaviour and facilitated acceptance of the disease. During group meetings, participants were encouraged to express their own needs and to deal with painful emotions including aggression, anger, mourning, and guilt. The caregivers felt relieved by sharing their problems with others. They were able to learn from each other and to exchange suggestions and solutions. The group also helped to establish new contacts and friendships. Participants' evaluations of the novel intervention were very positive. We conclude from these initial observations that support groups are needed for caregivers of patients with FTD which are tailored to their specific needs.

Adaptation, Psychological↗
PubMed2003

[German-speaking memory clinics: state of the art and practical recommendations].

The 7th annual meeting of the memory clinics of Germany, Switzerland and Austria in March 2002 in Göttingen, Germany was an optimal opportunity to make an inventory about the state of the art in diagnostic and therapy of dementia and mild cognitive impairment in German-speaking memory clinics. Several problems were discussed including difficulties in 1) diagnosis of patients with aphasia or foreign patients, 2) handling of demented patients without a caregiver, 3) psychological support for patients, who have been diagnosed in a very early stage, 4) misunderstandings between general practitioners, neurologists and psychiatrists in private practice on the one hand and the memory clinics on the other hand, 5) recommendations for prevention of dementia, 6) recommendations concerning dementia and car driving and 7) questions of genetic counselling. The following paper is a summary of the results of a workshop in Göttingen and gives practical recommendations based on the experiences of the memory clinics.

Aged↗
PubMed2003

Phospho-tau/total tau ratio in cerebrospinal fluid discriminates Creutzfeldt-Jakob disease from other dementias.

Early clinical symptoms of sporadic Creutzfeldt-Jakob disease (CJD) may overlap with other neurodegenerative diseases like Alzheimer's disease (AD) and frontotemporal degeneration (FTD). On entering an era in which pharmaceutical treatment of CJD occurs, reliable diagnostic markers like immunodetection of 14-3-3 proteins in the cerebrospinal fluid (CSF) are required. However, false negative results in autopsy-proven, sporadic CJD cases, as well as false positive results in several other disorders including AD and FTD showing high CSF tau protein levels, limit the potential of this marker. Due to neuronal lysis the cytosolic fraction of total tau containing phosphorylated and non-phosphorylated isoforms is partially liberated into the CSF. Since hyperphosphorylation of tau may specifically occur in neurodegenerative diseases associated with neurofibrillary changes, we hypothesized that the phospho-tau (P-tau)/total tau ratio in CSF may be a useful marker to discriminate CJD from other neurodegenerative disorders. The P-tau/total tau ratio discriminated patients with CJD from all other neuro-degenerative disorders including patients with AD and FTD without any overlap. Although the results have to be confirmed in a larger sample, the preliminary data suggest that simultaneous measurement of total tau and P-tau in CSF may be useful to identify patients with CJD.

Aged↗